Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 12088 | NC |
NPI | 1033694583 |
---|---|
Provider Name | Felicia Stakely |
First Address | Broadway, NC 27505-8121 |
Second Address | Fayetteville, NC 28301-2824 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2018 |
Last Update Date | 01/10/2018 |